Class II Restorative Solution

In these instances, I rely on Palodent® V3 sectional matrix system stackable wedges to compress and conform the matrix band to the tooth. Another option some clinicians apply as a pragmatic workaround is placing Teflon tape at the corners of the matrix band to customize and contour the band into root concavities. The key tip here is to use as little as possible of the tape and to make certain it does not affect the contact area.  I am not a proponent of burnishing the band as it will create an irregular contact and the bulk fill flowable will flow right to that spot. 

Current evidence demonstrates that placing a rubber dam is always the best option²⁶. You’re more likely to have a successful restoration with the rubber dam than without it. The key is to control the moisture. As clinicians, we're working in an environment that is not conducive to this type of procedure. Moisture, crevicular fluid, saliva and blood will interfere with the bond⁹ and cause failure. If the restorative field becomes contaminated, the bond to the tooth and the curing of the material will be impaired, potentially leading to premature failure. 

No.  I equate this to dipping your composite instrument into a bonding agent to help you adapt the composite. This changes the chemistry and physical properties of the composite and weaken the compressive strength. It also increases film thickness and creates an interference between the composite and the tooth structure.

Bonding agent is not needed in between layers, because as you place an increment and cure it, an air inhibited layer develops. This layer enables the next increment of composite to be bonded to the previous one.  

The only exception is when you're repairing a composite restoration. Here, you want to smooth out the existing restoration with a fine diamond and remove any biofilm. Then you're going to etch, rinse and dry. Next, you're going to place Silane Coupling agent, as this will improve the covalent bond between the new and the old composite. You air dry this and then continue with the bonding procedure and then place the composite. 

In the anterior region, I don’t use SDR® flow+ material in a bulk, I use it as a liner, anywhere I see dentin. I may only put a 0.5-millimeter increment. Then, depending on the size of the restoration, I will use one or two increments of Ceram.x Spectra® ST composite to finish the restoration. On premolars, if it's going to extend to the buccal surface, I will do this more carefully and use a smaller increment followed by Ceram.x Spectra® ST composite, especially if I have a patient that is very esthetically conscious. These situations are all relative to the patient and often very difficult to see unless the cheeks are retracted. 

I break these situations into two different scenarios: esthetic and non-esthetic areas. For esthetic areas, anything from second premolar forward, patient has a big smile line or a wide gummy smile, I use SDR® flow+ material as my dentin replacement, the initial increment. Then, I will place Ceram.x Spectra® ST composite in the same technique I use for a Class I or II restoration. When I have a non-esthetic area, I will still do two increments but both with SDR® flow+ material.  

Yes, it absolutely does, and we find that most of the newer materials are all comparable in compressive strength. Wear resistance comes down to what's going to happen at the margins and that is impacted by how you prepare the tooth, how you place the composite material and how you finish the restoration.  If you over finish the restoration, especially at the cavosurface margins, the wear resistance will drop.  Deterioration will set in, as well as discoloration. The objective should be to place the composite precisely, so you do not have to over finish it. Wear and strength over time is also influenced by the patients’ habits. Patients with a very strong bite and/or who chew on very hard foods are more prone to wear and fractures. The same is true for parafunctional habits like nocturnal bruxism, which must be controlled with an intraoral appliance.

I follow the Dentsply Sirona Class II Technique Guide

To put it simply, I let my patients know the longevity of the restoration is dependent, among other things, upon how well they care for their oral health. 

At the conclusion of the visit, I will inform them to eat on the other side of their mouth and choose a softer diet for 24 hours. This allows the tooth and area to settle down and not be traumatized further. I let my patients know that the tooth was diseased with decay caused by bacteria feeding on sugars and carbohydrates and producing an acid that creates the demineralization of the tooth structure. Additionally, I inform them that the restoration is more vulnerable to developing decay  than the adjacent tooth with no restoration.  It is important to inform your patients about their role in the long term success of their restorations. Along with reviewing proper homecare regimens I like to ask my patients what types of snack foods they eat. This allows me to make recommendations to their dietary habits that will help their restorations last longer.  Hard, crunchy, and chewy foods will expedite failure of all restorations, especially if a high content of sugar is part of the ingredients.  If a patient is developing tooth decay on a frequent basis, then adjunct high strength prescription fluoride toothpastes will not only help protect the vulnerable interproximal margins, but it will also motivate your patients to desiring higher levels of dental health.  If we do our part, then truly the outcome is based on how well they take care of their oral health.